Utilization Review Registered Nurse
Santa Rosa, CA
Prime Staffing
5x8 hrs

ID: 63763255 Shift: Day 5x8-Hour (08:00 - 16:30) Description: Remote UR RN Modified Time:7/13/2026 12:00:00 AM Account Manager: Jordan Hinojos Account Manager Email: COVID-19 Vaccine: Not Required Flu Vaccine: Unknown Submittals:High Job Requirements & Qualifications Previous Charge Experience : - Years of Experience : 3 Patient Ratio Experience : Charting System Experience : Required Charting System Name : Epic Community Hospital Experience : - LTAC Experience : - Trauma Level I Experience : - Trauma Level II Experience : - Travel Experience Required : Yes Certifications : Skills : Acute Hospital, Admission Criteria*, Admission Criteria*, Appeals and Denials*, Appeals and Denials*, Audits*, Audits*, Benefits Eligibility*, Care coordination*, CMS: Centers for Medicare and Medicaid Services*, Concurrent Review*, Concurrent Review*, Continued Stay Reviews*, Continued Stay Reviews*, CPT (Current Procedural Terminology) coding and billing*, CPT (Current Procedural Terminology) coding and billing*, Data Abstraction*, Data Abstraction*, Department of Health*, Determine Medical Necessity per Evidence-Based Guidelines*, Disability case management*, Discharge Planning*, Disease management*, DRG (Diagnosis Related Groups)*, HEDIS (The Healthcare Effectiveness Data and Information Set) Measures*, HIPAA guidelines (Health Insurance Portability and Accountability Act)*, ICD 10 Coding*, Insurance Company*, Long Term Acute Care/Rehab/Skilled Nursing*, Medical Necessity*, NCQA (National Committee for Quality Assurance)*, Needs Assessment/ Order DME*, OSHA*, Plan of Care*, Pre-Cert Review*, Pre-Cert Review*, Prior Authorization*, Prior Authorizations*, Quality Improvement*, Retrospective Review*, Retrospective Review*, Telephonic*, The Joint Commission/ Core Measure/National Safety Goals*, Utilize InterQual Criteria, Utilize InterQual Criteria, Utilize Milliman Guidelines*, Worker s comp case management*, Workers Compensation*, CA and Medi-Cal experience/knowledge * Unit Details Staffing & Scheduling Scheduling Type : Other Patient Ratios Days : 40 Patient Ratios Nights : - Patient Ratios Weekends : - Float Required : - Call Required : - Weekend Coverage : True Number of Weekend Shifts Per Contract : meet dept needs Pre-Approved Time Off : one Orientation Hours : 40 Facility & Patient Care Details Patient Age Groups : Neonates, Adolescents, Infants, Adults, Pediatrics, Geriatrics Daily Census : - Number of Visits Per Day : - Number of Rooms : - Number of Beds : - Additional Unit Information Interdisciplinary Support : - Patient Diagnoses : Interqual is a Hardstopacute care hospital experience is a requirement and a hardstop Special Procedures/Unit Details : 3-year acute medical Care Manager/UM experience performing utilization review in a hospital setting (not health plan/medical group) InterQual required, this is a Hardstop Experience with HMOs, IPAs, etc. Experience with Medicare regulations, regarding specific UM processes, such as CC44s, ABNs, HINNs, MCSNs, etc. Proficient with Epic, recent use required within the last 6-12 months Special Equipment : For those candidates staffing the centralized UM team, these are also some additional things we require:1.Every third weekend rotation for the length of contract.2.FLEXIBILITY our team supports three facilities and our caregivers will rotate between all three.3.Must work in Pacific Standard Time.4.Strict adherence to all CA labor laws regarding lunches, breaks etc. as well as -a.ZERO overtime unless approved by leadership prior to end of shift. b.ZERO working off the clock #Tier3 Travel Compliance We must have these three things before your traveler can be reviewed by our clinical team so please submit with this information included: What is their upcoming interview availability?. Please confirm the DOB and full SSN is correct in Connect. Skills Checklist found in documents must be completed and sent with submission. RTO: Aya Offer: 7 days RTO Client offer: 7 days RTO *Anything more will potentially delay your offer while we run approval by the client. To minimize turn around please limit total RTO requests Must commit to working 3 of the 5 holidays (Thanksgiving, Xmas Eve, Xmas Day, NYE, NYD) References Required: 2 References covering 1 year (6 months for CNA s) within the last 3 years during the compliance process and prior to start. Can include Charge RNs/Lead Local radius: 50 miles Local rule: accepted at lower BR, please reach out to AM for local rate ***** ALL travelers are expected to float between all facilities within a given state. travelers' refusal to float may result in termination of assignment and/or forfeiture of guaranteed hours.***** If required for the assignment, Client agrees to supply Providers with communication devices (i.e. cell phone, pager, etc.) needed to perform the duties as assigned at no cost to Provider or Agency. If Client does not provide a mobile phone required for the assignment, Client agrees to pay Agency monthly, for all work-related cell phone use by each Provider, up to a maximum amount of $50.00 as invoiced by Agency. Providers will be responsible for submitting monthly cell phone bill directly to Agency. Modules: Modules are non-billable, average 16 hours spent. Over 20 hours requires PM approval Modules are completed pre-start, and annually Time spent on modules is self-reported, completion is recorded in Workramp transcripts Submittal Details: #Tier3 Travel ComplianceWe must have these three things before your traveler can be reviewed by our clinical team so please submit with this information included:What is their upcoming interview availability?.Please confirm the DOB and full SSN is correct in Connect.Skills Checklist found in documents must be completed and sent with submission.RTO:Aya Offer: 7 days RTOClient offer: 7 days RTO*Anything more will potentially delay your offer while we run approval by the client.  To minimize turn around please limit total RTO requestsMust commit to working 3 of the 5 holidays (Thanksgiving, Xmas Eve, Xmas Day, NYE, NYD)References Required: 2 References covering 1 year (6 months for CNA s) within the last 3 years during the compliance process and prior to start.  Can include Charge RNs/LeadLocal radius: 50 milesLocal rule: accepted at lower BR, please reach out to AM for local rate***** ALL travelers are expected to float between all facilities within a given state. travelers' refusal to float may result in termination of assignment and/or forfeiture of guaranteed hours.*****If required for the assignment, Client agrees to supply Providers with communication devices (i.e. cell phone, pager, etc.) needed to perform the duties as assigned at no cost to Provider or Agency. If Client does not provide a mobile phone required for the assignment, Client agrees to pay Agency monthly, for all work-related cell phone use by each Provider, up to a maximum amount of $50.00 as invoiced by Agency. Providers will be responsible for submitting monthly cell phone bill directly to Agency.Modules:Modules are non-billable, average 16 hours spent. Over 20 hours requires PM approvalModules are completed pre-start, and annuallyTime spent on modules is self-reported, completion is recorded in Workramp transcripts Guaranteed Hours: Contract Weeks:91